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Universal health care? : access to primary care and missed health care of young adult Canadians Marshall, Emily Gard


Prevalence of missed health care by life course stage is examined with a critique of the measure of missed care. Canadians reporting missed care has increased from 4.2% in 1995 to 12.5% in 2001. Research questions: 1. Who reports missed care in Canada? 2. What are the relationships among life course stages, social support, predisposing, enabling and need factors to the reporting of missed care? 3. What is the role that life course stages play in the relationships among social support, predisposing, enabling, and need factors? 4. What kinds of health care are Canadians reporting they missed? 5. What reasons are provide for missing care?; and 6. Who accesses primary care and what is the relationship to reporting missed care? Methods: Analysis was done using the Canadian Community Health Survey Cycle 2.1. Nested multiple logistic regression models explore the relationships among variables of interest predicting missed care. Results: Young adults (18-30) are more likely to report missed care compared to other age groups and are least likely to have a regular doctor. Social support is most significantly protective against missed care for young adults. Weak sense of belonging to a local community and lower income are stronger predictors of missed care for young adults. Young adults differ from others in the reasons they report for missed care (i.e., more likely to report cost as a barrier). Discussion: It's not clear if the difference between young adults and other life course stages is in actual missed care or expectations of primary care. Yet, the literature on emerging adulthood invites curiosity about how delayed adulthood leaves them in less stable, financially insecure, socially and institutionally isolated situations that have subsequent consequences for primary care access. Changes in models of primary care have led to a decline in comprehensive care and more drop-in clinics; while, not having a regular doctor is associated with missed care. If patterns of inadequate primary care access established in young adulthood are perpetuated in later life, this may foretell undesirable consequences for the health of Canadians. A new model for measuring unmet health care needs is proposed.

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